FORM NO.

15G
[See section 197A(1), 197A(1A) and rule 29C]
Declaration under section 197A(1) and section 197A (1A) of the Income tax Act, 1961 to be made by an individual or a person
(not being a company or firm) claiming certain receipts without deduction of tax.

PART-I
1] Name of Assessee (Declarant) : 2]PAN of the Assessee :
3] Assessment Year
(for which declaration is being made)
4] Flat / Door / Block No. : 5] Name of Premises : 6] Status :
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7] Assessed in which Ward / Circle
8] Road / Street / Lane : 9] Area / Locality : 10] AO Code (under whom assessed last time) :
Area Code AO Type Range Code AO No.
Area Code AO Type Range Code AO No.
11] Town / City / District : 12] State :
13] PIN
14] Last Assessment Year in
which assessed :
15] Email : 16] Telephone (with STD code) /
Mobile No :
17] Present Ward / Circle
18] Residential Status :
(within meaning of
Section 6 of the Income
Tax Act, 1961)
Resident
19] Name of Business / Occupation : 20] Present AO Code (if not same as above):
21] Jurisdictional Chief Comm. of Income Tax or Comm. of
Income Tax (if not assessed to income tax earlier):
22] Estimated total income from the sources mentioned below:
(Please tick the relevant box)
Dividend from shares referred to in Schedule - I
Interest on securities referred to in Schedule - II
Interest on sums referred to in Schedule - III
Income from units referred to in Schedule - IV
The amt of withdrawal referred in sec-80CCA(2)(a) from National Savings Scheme referred to in Schedule - V
23] Estimated total income of the previous year in which income mentioned in Col - 22 to be included :
24] Details of investments in respect of which the declaration is being made :
SCHEDULE-I (Please see on the reverse)
SCHEDULE II
(Details of the securities held in the name of declarant and beneficially owned by him)
Description of
securities
Number of
securities
Amount of
securities
Date(s) of
(dd/mm/yyyy) securities
Date(s) on which the securities were
acquired by declarant (dd/mm/yyyy)
SCHEDULE III
(Details of the sums given by the declarant on interest)
Name and address of the person to
whom the sums are given on interest
Amount of sums
given on interest
Date on which the sums
were given on interest
(dd/mm/yyyy)
Period for which sums
were given on interest
Rate of interest
SCHEDULE - IV (Please see on reverse)
SCHEDULE - V (Please see on reverse)
Signature of the Declarant
Declaration / Verification
* I / We d o h e r e b y d e c l a r e t h a t t o t h e b e s t o f _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
* my / our knowledge and belief what is stated above is correct, complete and is truly stated. *I /We declare that the incomes referred to in this form are not includible in the total income of any other person
u/s 60 to 64 of Income Tax Act, 1961. *I/We further, declare that tax on *my / our estimated total income, including *income / incomes referred to in column 22 above, computed in accordance with provisions
of the Income Tax Act, 1961, for the previous year ending on relevant to the assessment year ____________ will be nil. *I / We also, declare that *my / our *income / incomes referred to in
Column 22 for the previous year ending on relevant to the assessment year will not exceed the maximumamount which is not chargeable to income tax.
_________
_________ __________
Place : _________
Date : _________
Signature of the Declarant
PART - II
[For use by the person to whom the declaration is furnished]
1] Name of the person responsible for paying the income referred to in Column 22 of Part I :
SHRIRAM TRANSPORT FINANCE COMPANY LIMITED
2] PAN of the person indicated in Column 1 of Part II
AAACS7018R
3] Complete Address :
MOOKAMBIKA COMPLEX IIIRD FLOOR,
NO.4, LADY DESIKACHARI ROAD,
MYLAPORE, CHENNAI - 600 004
4] TAN of the person indicated in
Column 1 of Part II : CHES00900E
5] Email :
6] Telephone / Mobile No :
7] Status : Domestic Company
044-24991363/24990356
8] Date on which Declaration is
Furnished (dd/mm/yyyy) :
9] Period in respect of which the dividend has
been declared or the income has been paid / credited :
10] Amount of
income paid :
11] Date on which the income has
been paid / credited (dd/mm/yyyy) :
12] Date of declaration, distribution or payment of dividend/withdrawal under
the National Savings Scheme(dd/mm/yyyy) :
13] Account Number of National Saving Scheme from which
withdrawal has been made :
Forwarded to the Chief Commissioner or Commissioner of Income tax ____________
Place : _________
Date : _________
Signature of the person responsible for paying the
income referred to in Column 22 of Part I
Class of units & face
value of each unit
Distinctive numbers
of the units
Date(s) on which the shares were acquired
by the declarant (dd/mm/yyyy)
SCHEDULE IV
(Details of the mutual fund units held in the name of declarant and beneficially owned by him)
Name and address of the
mutual fund
Number of
units
(Details of shares, which stand in the name of the declarant and beneficially owned by him)
No. of
shares
Class of shares & face
value of each share
Total value
of shares
Distinctive numbers
of the shares
Date(s) on which the shares were acquired
by the declarant (dd/mm/yyyy)
SCHEDULE I
SCHEDULE V
(Details of the withdrawal made from National Savings Scheme)
Particulars of the Post Office where the account under the
National Savings Scheme is maintained and the account number
Date on which the account
was opened (dd/mm/yyyy)
The amount of withdrawal
from the account
Notes:
FOR THE KIND ATTENTION OF DEPOSITORS
Incomplete forms are not accepted by the income tax authorities and therefore, could result in
deduction of tax at source. Please therefore, submit the form completed in all respects.
1. The declaration should be furnished in duplicate.
2. *Delete whichever is not applicable.
3. Declaration can be furnished by an individual under section 197A(1) and a person (other than a company or a firm) under section
197A(1A).
4. ** indicate the capacity in which the declaration is furnished on behalf of a HUF, AOP, etc
5. Before signing the declaration / verification, the declarant should satisfy himself that the information furnished in this form is true, correct
and complete in all respects.
Any person making a false statement in the declaration shall be liable to prosecution under 277 of the Incometax Act, 1961 and on
conviction be punishable
#
6. The personresponsible for paying the income referredtoincolumn22 of Part I shall not accept the declarationwhere the amount of income of
the nature referred to in subsection (1) or subsection (1A) of section 197A or the aggregate of the amounts of such income credited or paid or
likely to be credited or paid during the previous year in which such income is to be included exceeds the maximum amount which is not
chargeabletotax.";
1. Income-tax, wherever applicable, will bedeductedat sourceinaccordancewiththeIncomeTax Act, 1961, as amendedtoDate.
2. It may be noted that exemption from tax deduction will be granted only from the date of receipt of Form 15G and any tax deducted and
remittedtothegovernment beforethat datewill not berefundedbythecompanyunder anycircumstances.
3. The amount of Income-tax deducted at source is remitted to the credit of Central Government before the 7 day of the following month. Any
claimfor refund, will havetobemadebythedepositor totheincome-tax authorities byfilingaReturnof Income.
4. Form15G is a self declaratory formand does not require attestation by Govt. / Bank Official. However in case of thumb impression, the Form
15Gshould be attested by a Bank official or by a Gazetted Officer. For the deposit held in the name of Minor, the declaration should be signed by
theGuardian.
5. Beforereturningtheforms, depositors arerequestedtoensurethat all thecolumns aredulyfilledupandthat thesignatures havebeenaffixed.
6. Under the provisions of section 206AA, quoting of Permanent Account Number (PAN) in the declaration form 15G/H in Clause No.5 is
mandatory for non-deductionof Tax at Source. If PANis not quotedinthedeclarationform, theformwouldbeinvalidandtax will bedeductedat a
higher rateof 20%.
th
i)In a case where tax sought to be evaded exceeds twentyfive lakh rupees, with rigorous
imprisonment which shall not be less than 6 months but which may extend to seven years and with fine;
i)In any other case, with rigorous imprisonment which shall not be less than 3 months but which
may extend to two years and with fine.
FORM NO. 15H
[See Section 197A(1C) and Rule 29C(1A)]
Declaration under section 197A(1C) of the Income-tax Act, 1961 to be made by an individual who is of the age of sixty years or more claiming
certain receipts without deduction of tax.
Part - I
1. Name of Assessee (Declarant):
2. PAN of the Assessee :
4. Assessment Year :
(For which declaration is being made)
3. Age :
5. Flat/ Door/ Block No.: 6. Name of Premises: 7. Assessed in which Ward / Circle :
10. AO Code:
( Under whom assessed last time)
9. Area/ Locality: 8. Road/ Street/ Lane:
11. Town/ City/ District:
12. State :
13. PIN :
16. Telephone No. (with STD code) and
Mobile No.:
15. Email
18. Name of Business/ Occupation :
20. Jurisdictional Chief Commissioner of Income tax or Commissioner of Income Tax
( if not assessed to income-tax earlier)
21. Estimated total income from the sources mentioned below
22. Estimated total income of the previous year in which income mentioned in column 21 is to be included
23. Details of investments in respect of which the declaration is being made:
(Please see on the reverse)
(Details of the securities held in the name of the declarant and beneficially owned by him)
Schedule I
Schedule II
(Details of the sums given by the declarant on interest)
Schedule III
[For use by the person to whom the declaration is furnished]
PART II
(Please Tick the Relevant Box)
Dividend from Shares referred to in Schedule I
Interest on Securities referred to in schedule II
Interest on sums referred to in schedule III
Income from Units referred to in schedule IV
The amount of withdrawal referred to in Clause (a) of Sub section 2 of Section 80CCA referred to in schedule V
Description of
securities
Number of
securities
Amount of
securities
Date(s) of
(dd/mm/yyyy) securities
Date(s) on which the securities were
acquired by declarant (dd/mm/yyyy)
Name and address of the person to
whom the sums are given on interest
Amount of sums
given on interest
Date on which the sums were given
on interest (dd/mm/yyyy)
Period for which sums
were given on interest
Rate of interest
Schedule IV (Please see on the reverse)
Schedule V (Please see on the reverse)
Declaration / Verification
I _________________ do hereby declare that I am resident in India within the meaning of section 6 of the Income Tax Act, 1961. I also, hereby declare that to the best of my knowledge and belief what is
stated above is correct, complete and is truly stated and that the incomes referred to in this form are not includible in the total income of any other person u/s 60 to 64 of the Income Tax Act, 1961. I further,
declare that the tax on my estimated total income, including *income/ incomes referred to in column 21 computed in accordance with the provisions of the Income Tax Act, 1961, for a previous year ending
on 31st March relevant to the Assessment yearwill be nil.
________________________
Signature of the Declarant
________________________
Signature of the Declarant
Place :
Date :
1. Name of the person responsible for paying the income referred to in column 21 of Part I:
SHRIRAM TRANSPORT FINANCE COMPANY LIMITED
3. Complete Address:
MOOKAMBIKA COMPLEX IIIRD FLOOR,
NO.4, LADY DESIKACHARI ROAD,
MYLAPORE, CHENNAI - 600 004
4. TAN of the person indicated in column 1 of Part II:
CHES00900E
5. Email
8. Date on which declaration is furnished
(dd/mm/yyyy)
12. Date of declaration, distribution or payment of dividend /
ithdrawal under the National Savings Scheme (dd/mm/yyyy)
2. PAN of the person indicated in column 1 of Part II:
AAACS7018R
6. Telephone No. (with STD code) and
Mobile No.: 044-24991363 / 24990356
7. Status : Domestic Company
9. Period in respect of which the dividend
has been declared or the income has
been paid/ credited:
10. Amount of
Income Paid:
11. Date on which the income
has been paid/ credited (dd/mm/yyyy)
13. Account number of National Savings Scheme
from which withdrawal has been made:
Forwarded to Chief Commissioner or Commissioner of Income Tax..
Signature of the person responsible for paying the
income referred to in column 21 of Part I
Place :
Date :
Schedule I
(Details of shares, which stand in the name of the declarant and beneficially owned by him)
No. of shares
Name & Address of the Mutual Fund
Class of Shares & Face Value of Each Shares Total Value of Share Distinctive numbers of Shares
Date(s) on which the shares were acquired by the declarant
(dd/mm/yyyy)
Schedule IV
(Details of the mutual fund units held in the name of the declarant and beneficially owned by him)
No. of Units
Class of Unit and Face value of
each unit
Distinctive no. of Units Income in respect of units
Schedule V
(Details of withdrawal made from National Savings Scheme)
Particulars of Post Office where the account under the National Savings scheme is maintained and the
account number
Date on which the account
was opened (dd/mm/yyyy)
The amount of withdrawal
from account
1. The declaration should be furnished in duplicate.
2. * Delete whichever is not applicable.1.
3. Before signing the verification, the declarant should satisfy himself that the information furnished in the declaration is true, correct and complete in all respects.
Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income Tax Act, 1961 and on conviction be punishable
4. The person responsible for paying the income referred to in column 21 of Part I shall not accept the declaration where the amount of income of the nature
referred to in section 197A(1C) or the aggregate of the amounts of such income credited or paid or likely to be credited or paid during the previous year in which
such income is to be included exceeds the maximum amount which is not chargeable to tax and deduction(s) under Chapter VI A, if any , for which the declarant is
eligible.
1. Income-tax, wherever applicable, will be deducted at source in accordance with the Income Tax Act, 1961, as amended to Date.
2. It may be noted that exemption from tax deduction will be granted only from the date of receipt of Form 15H and any tax deducted and remitted to the
government before that date will not be refunded by the company under any circumstances.
3. The amount of Income-tax deducted at source is remitted to the credit of Central Government before the 7th day of the following month. Any claim for
refund, will have to be made by the depositor to the income-tax authorities by filing a Return of Income.
4. Form 15H is a self declaratory form and does not require attestation by Govt. / Bank Official. However in case of thumb impression, the Form 15H
should be attested by a Bank official or by a Gazetted Officer.
5. Before returning the forms, depositors are requested to ensure that all the columns are duly filled up and that the signatures have been affixed.
6. Under the provisions of section 206AA, quoting of Permanent Account Number (PAN) in the declaration form 15G/H in Clause No.5 is mandatory for
non-deduction of Tax at Source. If PAN is not quoted in the declaration form, the form would be invalid and tax will be deducted at a higher rate of 20%
(i) In a case where tax sought to be evaded exceeds twenty five lakh rupees, with rigorous imprisonment which shall not be less than six months but
which may extend to seven years and with fine ;
(i) In any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine.
Notes:
FOR THE KIND ATTENTION OF DEPOSITORS
Incomplete forms are not accepted by the income tax authorities and therefore, could result in
deduction of tax at source. Please therefore, submit the form completed in all respects.